The head and neck region harbours crucial structures and hence the surgical technique used to remove schwannomas from this region should cause minimal damage to these structures, with complete removal of pathology.

This study entailed a retrospective analysis of 10 patients with head and neck schwannomas that were excised using a nerve-sparing subcapsular dissection technique. The primary aims were to assess the functional impact of the surgical technique on the structure of origin and to evaluate local control.

One patient with parapharyngeal schwannoma developed symptoms suggestive of ‘first bite syndrome’ in the late post-operative period. Another patient with facial nerve schwannoma had House–Brackmann grade II weakness in the immediate post-operative period, which subsequently resolved. None of the patients developed recurrence during a median follow-up period of two years.

The nerve-sparing subcapsular dissection technique provided effective local control of tumour pathology, with relative preservation of neural function post-operatively.

The false thyroid capsule is an important anatomical structure involved in thyroidectomy, yet it is rarely studied. This study aimed to define the anatomy of the false thyroid capsule, and its clinical significance.

A prospective study was performed involving 151 patients with goitre who underwent thyroid lobectomy. The anatomy of the false thyroid capsule was carefully documented intra-operatively.

The false thyroid capsule enclosed the inferior and middle thyroid veins and the superior thyroid vessels, forming a mesentery-like structure by attaching to the gland. Once the unilateral lobe had been removed, the thyroid mesentery could be seen to have a C-shaped edge. The recurrent laryngeal nerve, inferior thyroid artery and parathyroid glands were located beneath the C-shaped edge of the thyroid mesentery.

The thyroid mesentery is a distinctive structure that can be used as a guide for surgical dissection.

To determine the number of children undergoing tonsillectomy that could have this performed as a day surgery procedure.

This paper reports a prospective cohort study, which entailed a comparison of children's eligibility for day-case surgery between 2001 and 2011 and an assessment of the Scottish Index of Multiple Deprivation scores.

In total, 148 children were enrolled. In 2011, 60 children (42 per cent) were eligible for surgery with same day discharge compared with 27 per cent in 2001. The percentage of children undergoing tonsillectomy for sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome increased from 26 per cent to 55 per cent.

Eligibility for tonsillectomy with same day discharge has increased. This appears to be related to an increase in the number of children who are able to fulfil the social criteria for same day discharge. The results indicate an association between deprivation and tonsillectomy, particularly surgery carried out for the symptoms of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome. There has been a significant increase in the percentage of children undergoing tonsillectomy for the indication of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome.

Frontal sinus involvement in aspergillosis associated with the nose and paranasal sinuses is a common occurrence, but the incidence of primary frontal sinus aspergillosis is rare, and there are few reports in the English literature.

This study aimed to evaluate the role of the endonasal endoscopic surgical approach for isolated primary frontal sinus aspergillosis.

This paper describes a retrospective study of 16 cases of primary frontal sinus aspergillosis. The patients had presented to the out-patient services of the Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India, between January 1999 and July 2011.

The overall success rate of the endonasal endoscopic approach was 82.25 per cent. The disease recurred in three patients and was subsequently managed using the modified Lothrop procedure.

Minimally invasive endonasal endoscopic sinus surgery was found to be an effective and a safe approach for managing primary frontal sinus aspergilloma, even in cases with larger bony defects involving the posterior table of the frontal sinus.

To investigate the relationship between development of laryngeal cancer and the presence of polymorphisms of the MnSOD Val16Ala, CAT-262 C < T and GPx1 Pro198Leu genes in a smoking population.

Single nucleotide polymorphisms were determined in DNA from the peripheral blood erythrocytes of 48 heavy smokers (25 patients with laryngeal cancer and 23 cancer-free controls), using polymerase chain reaction.

There were no significant differences in age, smoking duration or smoking intensity, comparing the two groups. The homozygous AA genotype of MnSOD Val16Ala was significantly more prevalent in the cancer group than the control group (92 vs 13 per cent, respectively), while the heterozygous AV genotype of MnSOD Val16Ala was more prevalent in the control group than the cancer group (87 vs 8 per cent, respectively) (p < 0.001). There were no significant differences between the cancer and control groups regarding GPx1 Pro198Leu or CAT-262 C < T polymorphisms.

Polymorphism of the MnSOD Val16Ala gene may contribute to susceptibility to laryngeal cancer among smokers.

Kimura's disease is a rare, localised, chronic inflammatory disease. This benign disease involves subcutaneous tissues, the major salivary gland, and lymph nodes primarily in the head and neck area.

Clinical details and stained slides of all cases reported as Kimura's disease over a 10-year period were reviewed.

There were eight cases of Kimura's disease. The mean age of patients was 22.8 years. One case showed associated nephrotic syndrome and two cases were associated with peripheral blood eosinophilia. All cases showed the typical histopathological features of Kimura's disease.

Kimura's disease was first reported in China in 1937. The cause of Kimura's disease is unknown and many theories have been proposed. The eight cases reported here illustrate some of the variations in the mode of presentation and in the histological features of Kimura's disease. Kimura's disease should be considered in the differential diagnosis of patients who present with head and neck swellings and lymphadenopathy, and investigated accordingly.

To evaluate the incidence of pharyngocutaneous fistula after pharyngolaryngectomy with and without a Montgomery salivary stent.

Retrospective analysis of patients with factors that predispose to the development of pharyngocutaneous fistula (i.e. disease extending to the supraglottic region, base of the tongue or pyriform sinuses, and/or radiochemotherapy).

Between 2002 and 2008, 85 pharyngolaryngectomies were performed in our clinic. Of these patients, 31 were at increased risk of fistula development, of whom 45 per cent developed fistulas post-operatively. This subgroup of 31 patients was compared with a second subgroup of 22 patients at high risk of fistula development, treated between 2009 and 2011 with pharyngolaryngectomy and with a Montgomery salivary stent placed in advance during closure of the neopharynx.

Statistical analysis showed a significant reduction in the rate of fistula development, from 45 to 9 per cent (p < 0.01), with application of the salivary stent.

These data confirm the preventive effect of a salivary stent placed during pharyngolaryngectomy, for patients at high risk of fistula development.

To audit out-of-hours flexible endoscope disinfection practice in England and compare the findings with a previously published first audit cycle, with the 2005 ENT UK guidelines as the key intervention.

A telephone survey of the 104 ENT units in England was conducted out-of-hours, replicating the first cycle. The on-call clinician answered questions concerning access to flexible endoscopes, training, disinfection procedures and record keeping. Information regarding the clinician's trainee grade and their cross-covering duties was also acquired. Responses were compared to the first cycle results and published guidance.

In total, 72 of the 104 units agreed to participate. The on-call clinician cleaned the flexible endoscope in 43 per cent of units. However, adequate training in disinfection only occurred in a minority of units (37 per cent), though this was an improvement from the first cycle (12 per cent). Furthermore, 27 per cent of units used an inadequate method of disinfection out-of-hours. One confounding factor may be the increase in cross-cover out-of-hours, with 68 per cent of respondents covering one or more other specialties.

An overall moderate improvement in the safety of out-of-hours endoscopy in the past 10 years cannot obscure the urgent need for universal compliance with national guidelines.

To assess the feasibility and clinical value of using the CellSearch system to detect circulating tumour cells in patients with advanced-stage head and neck squamous cell carcinoma.

Circulating tumour cells were isolated and counted via positive selection utilising magnetically labelled anti-epithelial cell adhesion molecule and immunocytochemical staining for cytokeratin. The correlation between circulating tumour cell presence and clinical features was evaluated in nine patients newly diagnosed with advanced-stage (stage III or IV) head and neck squamous cell carcinoma.

Circulating tumour cells were detected in three of the nine patients (33 per cent). Circulating tumour cell positivity was more prevalent in node stage 2 to 3 patients (3 of 5, 60 per cent) than node stage 0 to 1 patients (0 of 4, 0 per cent). Recurrent or progressive disease was observed in only one of the six patients (17 per cent) without circulating tumour cells, compared with two of the three patients (67 per cent) with circulating tumour cells.

In this preliminary study, circulating tumour cells were successfully isolated in patients with advanced-stage head and neck squamous cell carcinoma, using the CellSearch system. Further investigation is needed to evaluate the prognostic significance of circulating tumour cells.

To assess the impact of anti-reflux treatment and speech therapy on subjective voice measurements of patients with laryngopharyngeal reflux.

This paper reports a prospective study of patients seen in a voice clinic over a three-year period who were being treated for laryngopharyngeal reflux. Patients were assessed at presentation using the reflux symptom index and voice symptom scale, and were reassessed at three months and six months post-treatment. Treatment entailed twice daily proton pump inhibitor therapy and speech therapy.

The study comprised 74 patients. The reflux symptom index and voice symptom scale scores significantly improved following treatment at both three and six months. There was a correlation between improved reflux symptom index scores and improved voice symptom scale scores.

Treatment of laryngopharyngeal reflux with twice daily proton pump inhibitors and speech therapy resulted in improved subjective voice measurements for patients.

Laryngeal cryptococcosis is a rare condition. In this report, we describe the findings for and treatment of a 58-year-old man with Cryptococcus gattii infection of the right vocal fold.

Case report and review of the relevant English language literature.

The patient presented with persistent hoarseness of voice. Laryngoscopy demonstrated an irregular, red lesion on the right vocal fold. Histopathological examination identified cryptococcus. The patient was treated with oral fluconazole 400 mg/day for eight weeks.

Laryngeal involvement by Cryptococcus gattii can result from prolonged inhaled corticosteroid therapy and proximity to eucalyptus trees. The clinical presentation, laryngoscopic findings and imaging results of laryngeal involvement may mimic a neoplasm. Histopathological examination can demonstrate the causative organism. Management consists of advice from an infectious disease specialist together with adequate treatment by antifungal agents.

This study aimed to examine the feasibility of an endonasal, transmaxillary, transpterygoid approach to the foramen ovale by examining key anatomical, radiological and surgical landmarks.

Measurements were taken from 183 patients' computed tomography scans using BrainLAB iPlan 1.1 Cranial software. Endoscopic dissection was then carried out on a cadaver to assess surgical viability.

We found that the distances from the posterior maxillary wall to the foramen ovale and from the anterior nasal spine to the foramen ovale were statistically significantly larger in men than women. The distance from the base of the lateral pterygoid plate to the foramen ovale, and the angle between the foramen ovale, the anterior nasal spine and the sphenoid rostrum, were constant between the sexes. The importance of the lateral pterygoid plate in locating the foramen ovale was demonstrated.

With the increasing popularity of image guidance and assisted navigation in endoscopic surgery, these findings increase anatomico-radiological understanding of the surgical approach investigated.

To review our experience with freehand core-needle biopsy in the assessment of unexplained head and neck masses.

A total of 770 patients with head and neck masses (referred over a 22-month period) were evaluated. A retrospective chart review was performed on 53 of those patients who underwent core-needle biopsy for an unexplained mass.

Correct sampling of the target tissue was achieved in all 53 patients (100 per cent) using a freehand core-needle biopsy technique. The diagnostic accuracy for providing adequate tissue samples for histopathological diagnosis was 96 per cent; the test sensitivity was 92 per cent. Four patients (7 per cent) required open surgical biopsy prior to commencing definitive treatment.

Out-patient freehand core-needle biopsy can be carried out safely on select patients with head and neck masses, and provides high quality histopathology specimens with high diagnostic utility.

Diagnostic ability is essential in laryngology. The UK Higher Surgical Training syllabus includes competencies specific to laryngology. This study aimed to identify the factors in training that lead to a consultant level of laryngology-related diagnostic ability.

An online test of training experience was constructed using laryngoscopy videos obtained from a specialist UK voice clinic. Participation was aimed at both trainees and trainers via invitation through national ENT forums.

There were 51 complete responses. Trainees with six months of laryngology experience scored significantly higher than those without this experience (p < 0.001). There was no improvement in score demonstrated for those with head and neck specialty experience without laryngology experience. Trainees who had completed 12 months of laryngology, or 6 months of laryngology coupled with 12 months of head and neck training, scored similarly to their consultant trainers.

It is recommended that all trainees have at least six months of experience in a specialist voice or laryngology placement prior to gaining the Certificate of Completion of Training.

To evaluate the incidence of subglottic stenosis in children undergoing endotracheal intubation.

Children in the paediatric intensive care unit of a tertiary care hospital were considered eligible for inclusion if they received endotracheal intubation for more than 24 hours. After extubation, children underwent flexible fibre-optic nasolaryngoscopy. Based on this first evaluation, they were divided into two groups: ‘acute normal’, with mild laryngeal alterations or normal findings; and ‘acute alterations’, with moderate to severe laryngeal alterations. Further laryngoscopic follow up (7–10 days later) was undertaken for those children in the acute normal group who developed symptoms during follow up (after discharge from the intensive care unit), and for all children in the acute alterations group. Children were then classified into two final groups: ‘normal final examination’, with no chronic changes; and ‘subglottic stenosis’.

We included 123 children. The incidence of subglottic stenosis was 11.38 per cent (95 per cent confidence interval, 6.63–17.94 per cent). All the children who developed subglottic stenosis had had moderate to severe alterations immediately after extubation.

This incidence of subglottic stenosis is quite high and needs further investigation to identify risk factors.

To evaluate the results of treatment of parotid pleomorphic adenoma, and the risk factors for secondary recurrence.

Single-centre, retrospective study of 32 patients with pleomorphic adenoma recurrence managed between 1988 and 2008.

The mean age at diagnosis of primary pleomorphic adenoma recurrence was 43.4 years. Twenty-eight per cent of patients had secondary recurrence; 32 per cent had undergone two or more surgical resections and external adjuvant radiotherapy. An age of less than 25 years was significantly associated with an earlier primary recurrence (p = 0.008). The most significant histopathological risk factor for secondary recurrence was the presence of a multifocal tumour (p = 0.019). Other histopathological criteria (i.e. cellularity and capsule rupture) were not significant. Radiotherapy was not associated with a decrease in recurrence. Nine per cent of patients progressed to malignancy. The main surgical complication was definitive facial palsy (14 per cent).

Pleomorphic adenoma recurrence requires surgery, with greatly increased risk to the facial nerve. Resection with clear surgical margins is required, especially in young patients with multifocal tumours. Radiotherapy may delay second recurrence in cases of multifocal tumour.

To present and evaluate the use of nasal dermoplasty for control of recurrent nasal polyps.

Prospective case series.

The mucosa of the fovea ethmoidalis and the lamina papyracea was replaced by a split-thickness skin graft. The follow-up period ranged from 2 to 12 months.

Five patients underwent nasal dermoplasty for recurrent nasal polyposis. In three cases, the graft uptake was successful. Post-operatively, four patients reported they were in better condition than at the same interval after their previous operation. Recurrence of polyps was noted in all patients but not in the grafted areas.

In this study, there was a high prevalence of successful graft uptake following nasal dermoplasty. This technique may have potential for the control of recurrent nasal polyps. Although it is demanding and time-consuming, it may reduce the need for multiple operations. Further research is justified to establish its efficacy.

Obstructive sleep apnoea is a common condition that is unfortunately associated with a high rate of patient non-compliance regarding device use. Newer surgical interventions have focused on procedures at the palate level, using variants of palatoplasty and transpalatal advancement. However, the extent of tongue reduction surgery required remains controversial. The authors propose an in-between variant that combines midline glossectomy resection (with minimal mucosal sacrifice) and lateral coblation tongue channelling.

Four patients underwent a coblation-assisted Lewis and MacKay operation, which is a new technique for tongue reduction. This involved a midline glossectomy combined with lateral coblation channelling of the tongue, alone or as part of major airway reconstruction. Demographic, polysomnographic and quality of life questionnaire data were collected prospectively and analysed.

No significant complications were noted in the four patients. (Results of the post-surgical outcomes are presented in another paper.) The coblation-assisted Lewis and MacKay operation reduced the potential complications of aggressive tongue surgery. The contours of the tongue were maintained, but significant reduction was still achieved.